Quality indicators are quantitative measures used to evaluate the quality of health care. They are often based on clinical practice guidelines and are designed to encourage effective, evidence-based care.1 Quality indicators are becoming increasingly important, with Medicare, the Department of Veterans Affairs, and commercial managed care plans implementing pay-for-performance programs that tie reimbursement to these indicators. However, for medically complex older patients, there are concerns that closer adherence to current quality indicators may lead to unintended harms.1-3